COSHH-Risk-Assessment-Form by sdaferv

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									H2 – COSHH ASSESSMENT FORM

COSHH Risk Assessment Form Name of Faculty/Department Date of Assessment Description of Activity/Procedure/Process (include SOPs as aControl) Name of School Site/Location/Room No

Name of Techniques to be Used

Name of Assessor/Supervising Assessor Persons at Risk (Who?) Type of Health Surveillance Required Health Status (are special arrangements required?)

Signature

Tel No. E-mail Total number (e.g. in lab) Duration of Exposure: mins/hrs Are there any Ethical Issues? Y / N (Attach Consents)

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H2 – COSHH ASSESSMENT FORM

Emergency Contact Names

Tel No.

Description of Waste Disposal Methods In accordance with SOPs for lab No. _________

Emergency Action/Procedures

Training/Direct Supervision Requirements

Business Interruption (e.g. power shutdown, fire, flood) What are the Contingency Procedures for work and waste?

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H2 – COSHH ASSESSMENT FORM

Risk Evaluation Comments

COSHH MATERIAL SAFETY DATA TECHNIQUE/METHOD TITLE: Hazardous Hazar State Substance d e.g. (including Type solid, Organisms) ,liquid , gas

Quantity used

Route of entry & Target Organs

WEL

Controls and Precautions

Disposal Route Spillage procedure Emergency procedures

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H2 – COSHH ASSESSMENT FORM

COMMENTS: Attach any additional hazard data, consider any substance with an allocated WEL. Use EH40 Guidance HSE RISK RATING HIGH MEDIUM LOW

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